Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases

Hahnemann, Maria L.; Ringelstein, Adrian; Sandalcioglu, I. Erol; Goericke, Sophia L.; Moenninghoff, Christoph; Wanke, Isabel; Forsting, Michael; Sure, Ulrich; Schlamann, Marc

doi:10.1136/neurintsurg-2013-010820

Cited by 46 publications

(49 citation statements)

References 26 publications

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“…In a series of 34 consecutive patients undergoing elective coiling for unruptured aneurysms, Matsushige et al 20 reported that 76% of patients had high-signal spots on DWI. Hahnemann et al 21 found that nearly two-thirds of patients undergoing stent-assisted coiling had postprocedural ischemic lesions on DWI in a series of 75 patients. Our study is considerably smaller, and further studies reporting the incidence of DWI changes following PED placement are necessary.…”

Section: Discussionmentioning

confidence: 99%

Patency of the Anterior Choroidal Artery after Flow-Diversion Treatment of Internal Carotid Artery Aneurysms

Brinjikji¹,

Kallmes

Cloft

et al. 2014

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Patency of the Anterior Choroidal Artery after Flow-Diversion Treatment of Internal Carotid Artery Aneurysms

Brinjikji¹,

Kallmes

Cloft

et al. 2014

AJNR Am J Neuroradiol

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“…2-4, 8,9,15,22,[24][25][26] One possible reason for the lower rate in our study may have been the strict anticoagulation and antiplatelet regimen that was used. Our patients received premedication with 2 antiplatelet drugs for > 5 days (preferably ~ 10 days) prior to their procedure, regardless of whether the use of a stent was anticipated.…”

Section: 23mentioning

confidence: 99%

“…If we did not include other variables such as the assistive techniques, the result could have differed, as was suggested by another report. 9 The use of antithrombotics such as antiplatelet and anticoagulant drugs is obviously a very important issue. Heparin use has previously been suggested as an important variable.…”

Section: 23mentioning

confidence: 99%

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Microembolism after endovascular coiling of unruptured cerebral aneurysms: incidence and risk factors

Park¹,

Lee

Kim

et al. 2016

JNS

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M icroembolic lesions appearing as high signal intensity (HSI) spots on diffusion-weighted imaging (DWI) and restrictive diffusions on the corresponding apparent diffusion coefficient (ADC) maps are often seen following a variety neurovascular procedures. Reportedly, 10% to 76.5% of DWI studies obtained after endovascular coiling of unruptured intracranial aneurysms (UIAs) show such microembolic spots (Fig. 1). [2][3][4]8,9,15,22,[24][25][26] Most patients who show HSI spots are asymptomatic, and the clinical significance of such spots remains controversial. However, the HSI spots reflect the presence of damaged tissue, 5,7,12,15 and their associated potential risks cannot be ignored.This study was conducted to analyze the current incidence of postprocedural DWI HSI lesions at our institution and to explore the possible risk factors for microembolic lesions visible as HSI spots on DWI after endovascular coiling of UIAs. Methods Patient PopulationOur local institutional review board approved this retrospective study, and the requirement for patient informed consent for data collection and analyses was waived. We used our neurointerventional database to identify a total of 293 consecutive patients who had presented with a UIA for endovascular treatment between July 2011 and June 2013. Among 293 patients, we excluded 13 patients in whom the aneurysm was treated with parent artery trapping without endosaccular coiling and 2 other patients in whom endovascular management was unsuccessful due to selection aBBreViatiONS ACT = activated clotting time; ADC = apparent diffusion coefficient; BMI = body mass index; DM = diabetes mellitus; DWI = diffusion-weighted imaging; HSI = high signal intensity; PRU = P2Y12 reaction unit; UIA = unruptured intracranial aneurysm. OBJectiVe The incidence and risk factors of microembolic lesions on MR diffusion-weighted imaging (DWI) were analyzed after the endovascular coiling of unruptured intracranial aneurysms (UIAs). MethOdS Data obtained from 271 consecutive patients (70 men and 201 women; median age 57 years; range 23-79 years) who presented with UIA for coil embolization between July 2011 and June 2013 were analyzed. Two independent reviewers examined the DWI and apparent diffusion coefficient maps obtained the following day for the presence of restrictive diffusion spots and counted the number of spots. Multivariate analysis was then performed to identify independent risk factors for developing microembolism following the coiling of an aneurysm. reSultS Microembolic lesions were noted in 101 of 271 patients (37.3%). The results of the multivariate analysis showed that the following factors significantly influenced the risk for microembolism: age, diabetes, previous history of ischemic stroke, high-signal FLAIR lesions in the white matter, multiple aneurysms, and the insertion of an Enterprise stent (all ORs > 1.0 and all p values < 0.05). Previously known risk factors such as prolonged procedure duration, aneurysm size, and decreased antiplatelet function did not show any signific...

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“…[3][4][5] To reduce thromboembolic complications, many studies investigated the association between thromboembolism and aneurysm and/or patient factors. [5][6][7][8] Previous studies have demonstrated that 30%-60% of endovascular coil embolizations for unruptured aneurysms show ischemic lesions on postprocedural diffusion-weighted images. Although most of the lesions seem to be benign, some could result in permanent neurologic sequelae.…”

mentioning

confidence: 99%

Association between Postprocedural Infarction and Antiplatelet Drug Resistance after Coiling for Unruptured Intracranial Aneurysms

Ms¹,

Yeon³

et al. 2016

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Procedure-related thromboembolism is a major limitation of coil embolization, but the relationship between thromboembolic infarction and antiplatelet resistance is poorly understood. The purpose of this study was to verify the association between immediate postprocedural thromboembolic infarction and antiplatelet drug resistance after endovascular coil embolization for unruptured intracranial aneurysm.

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Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases

Cited by 46 publications

References 26 publications

Patency of the Anterior Choroidal Artery after Flow-Diversion Treatment of Internal Carotid Artery Aneurysms

Patency of the Anterior Choroidal Artery after Flow-Diversion Treatment of Internal Carotid Artery Aneurysms

Microembolism after endovascular coiling of unruptured cerebral aneurysms: incidence and risk factors

Association between Postprocedural Infarction and Antiplatelet Drug Resistance after Coiling for Unruptured Intracranial Aneurysms

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